Anterior hip replacement is a surgical approach for total hip replacement. It is a minimally invasive, muscle sparing approach that is generally associated with a faster early recovery for the patient. Long term outcomes are similar to conventional posterolateral hip replacement.
Not all patients are suitable for anterior hip replacement. It depends on the individual anatomy. I will advise you if you are more suitable for an anterior or posterior approach. If I think that you will achieve a better result with a posterolateral approach I will recommend it to you. Anterior approach hip replacements are generally more stable initially than posterior approach hip replacements, thus requiring fewer post-operative precautions, however, as I generally use dual mobility hip implants, stability is excellent with both anterior and posterior approaches such that post-op precautions are unnecessary.
Following anterior hip replacement you are free to mobilise fully weight bearing immediately after surgery. In practice this usually means the following day. As soon as you are comfortably mobile you may leave hospital for home or a rehab facility. This can take 2-4 days but is very flexible and tailored to the individual.
Anterior hip replacement is an extremely successful operation with a very high patient satisfaction rate.
The prestigious British medical journal The Lancet has called hip replacement the 'operation of the century' due to its reliability and capacity to improve the quality of life of sufferers of hip arthritis.
There are no restrictions on activities after the operation with an anterior approach hip replacement.
Indications
Hip replacement is indicated in patients with arthritis of the hip.
Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn out causing pain and inflammation. Some of the causes of arthritis include:
- Advancing age
- Congenital or developmental hip diseases
- Obesity
- Previous history of hip injury or fracture
- Increased stress on hip because of overuse
Symptoms
Patients with arthritis have worn out articular cartilage, a narrowed joint space, and may have bone spurs or excessive bone growth around the edges of the hip joint. Patients with arthritis experience pain, stiffness, and loss of movement.
Diagnosis
The diagnosis is made by taking a history, performing a medical examination, and with the use of X-Rays and sometimes MRI scans.
Procedure
Direct anterior total hip replacement surgery involves the following steps:
- The procedure is performed under general or spinal anesthesia or both.
- A special operating table is used to enable the operation to be done using a minimally invasive technique.
- The incision is usually about 4 inches long on the front of the thigh. The major muscles are pushed aside to gain access to the joint and perform the replacement.
- Next, the femur bone is separated from the acetabular socket.
- The acetabular surface is prepared using a special instrument called a reamer.
- The acetabular component is fixed into the socket.
- The femur is prepared using special instruments so that the new titanium implant fits perfectly into the bone.
- Fluoroscopic imaging (X-Rays) are taken during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.
- The femoral head component made of ceramic or metal is then placed on the femoral stem.
- Long acting local anaesthetic is injected into the wound.
- Tranexamic acid is injected into the hip. This dramatically reduces any post-operative bleeding into the joint. It has made blood transfusions mostly unnecessary after hip replacement surgery.
- The incisions are closed with sutures and covered with a sterile waterproof dressing.
Post-operative care
With the anterior approach you will not have to follow standard hip precautions.
You are advised to:
- Take medications as prescribed to relieve pain and prevent infection
- Participate in physical therapy to restore hip function and strength
- Eat a healthy diet to facilitate healing
- Do not smoke
Contact your doctor if you observe increasing swelling or redness in the operated area.
Risks and complications
Complications following direct anterior hip replacement are uncommon but may include the following
- Infection at the incision site or in the joint space
- Fracture
- Superficial nerve damage. Thigh numbness is common following anterior approach hip replacement. It usually but not always settles with time. Sometimes it can be associated with 'nerve type pain' that may be difficult to treat.
- Major nerve damage causing weakness is uncommon.
- Hemarthrosis-excess bleeding into the joint after the surgery
- Deep vein thrombosis (blood clot)
- Leg length inequality
- Other rare complications
